Exploring Barriers and Facilitators to Self-Management for Patients With Persistent Musculoskeletal Conditions Following NHS-Led Hydrotherapy: A Service Evaluation.

Abstract

Introduction: Persistent musculoskeletal (MSK) disorders are one of the leading reasons for years lived with disability within the UK. Guidelines encourage integrating self-management support. Hydrotherapy supports patients with persistent MSK conditions; however, self-management following NHS-led hydrotherapy has been inconsistent.

Aim: To identify outcomes of hydrotherapy alongside the barriers, facilitators, and contributory factors affecting self-management in the local persistent MSK pain population.

Methods: Between April 2023 and May 2023, a service evaluation was undertaken exploring factors affecting self-management in the local persistent MSK pain population following NHS-led hydrotherapy. Demographics, clinical factors, functional status (MSK-HQ) and patient-reported experiences, including barriers and facilitators to self-management, were recorded. Data was analysed using descriptive statistics alongside exploration of themes.

Results: Ninety patients completed hydrotherapy. White British (n = 24) and Indian British (n = 23) were the most common groups to attend. Multiple joint (n = 27) and spinal conditions (n = 26) were the most common MSK conditions. Mean pre- and post-MSK-HQ scores were 20.8 and 26.1, respectively. Among the contactable patients (n = 69), 49 patients did not maintain independent water-based self-management reporting barriers such as ongoing support, access and financial concerns. Patients supported the establishment of a support group (n = 56) to help maintain water-based exercises.

Conclusions: The local persistent MSK pain population lacks self-efficacy for independent water-based self-management. A supportive and collaborative approach is proposed to address this via a patient-led hydrotherapy support group.